Functional disturbances of the masticatory system in an elderly population group

Rehabilitation of a deep bite patient with worn dentition using minimally invasive approach: A 3-year follow-up

Full mouth rehabilitation of severely worn teeth represents a challenging situation for dental clinicians. This case report describes the minimally invasive interdisciplinary approach for treatment of severely worn dentition with a loss of vertical dimension of occlusion. After 3 years of follow-up, no complication was observed.

Frequency of temporomandibular joint osteoarthritis and related symptoms in a hand osteoarthritis cohort

OBJECTIVE

The prevalence of osteoarthritis (OA) in the temporomandibular joints (TMJs) in hand OA patients is largely unknown. Our aims were to explore (1) The frequency of TMJ-related symptoms and clinical findings; (2) The TMJ OA frequency defined by cone beam computed tomography (CBCT); and (3) The relationship between TMJ-related symptoms/clinical findings and CBCT-defined TMJ OA, in a hand OA cohort.

METHODS

We calculated the frequencies of TMJ-related symptoms, clinical findings and diagnosis of TMJ OA by CBCT and clinical examination in 54 patients from the Oslo hand OA cohort (88% women, mean (range) age 71 (61-83) years). Participants with and without CBCT-defined TMJ OA were compared for differences in proportions (95% confidence interval (CI)) of symptoms and clinical findings. Sensitivity and specificity of the clinical TMJ OA diagnosis were calculated using CBCT as reference.

RESULTS

Self-reported symptoms and clinical findings were found in 24 (44%) and 50 (93%) individuals (93%), respectively, whereas 7 (13%) had sought healthcare. Individuals with CBCT-defined TMJ OA (n = 36, 67%) reported statistically significantly more pain at mouth opening (22%, 95% CI 4-40%), clicking (33%, 95% CI 14-52%) and crepitus (25%, 95% CI 4-46%). By clinical examination, only crepitus was more common in TMJ OA (33%, 95% CI 29-77%). Clinical diagnosis demonstrated low sensitivity (0.42) and high specificity (0.93).

CONCLUSIONS

CBCT-defined TMJ OA was common in hand OA patients, suggesting that TMJ OA may be part of generalized OA. Few had sought healthcare, despite high burden of TMJ-related symptoms/findings. Clinical examination underestimated TMJ OA frequency.

Inter-examiner reliability in the clinical examination of temporomandibular disorders: influence of age

OBJECTIVE

The aim of this study was to investigate the influence of the age of the subject on inter-examiner reliability of the clinical signs of temporomandibular disorder (TMD).

METHODS

Forty-three elderly (ES) and 44 younger adults (YS) were selected. The female/male distribution was almost the same in the two groups. All participants underwent clinical examination according to the Research Diagnostic Criteria for TMD, performed successively by two clinicians.

RESULTS

For metric measurements - with the exception of unassisted opening - the ES gave a significantly lower range of motion with both examiners and significantly worse percentage agreement between the examiners. A remarkable inter-examiner disagreement in the elderly was found with laterotrusion and protrusion movements. The prevalence of joint sounds was rated inconsistently by the examiners. The reliability of detection was not different in the two groups. The prevalence of tender muscle sites was also inconsistent. The overall percentage agreement for subjects with at least one tender muscle point was not age dependent. Because of the very low prevalence in ES, further statistical assessment of reliability is not possible.

CONCLUSIONS

The age-dependent lower range of motion and the inferior reliability of metric measurements in the elderly could lead to wrong diagnoses. The reliability of detecting joint sounds and tender muscles was not age dependent within the limitations of the study.

The prevalence of signs and symptoms of temporomandibular disorders in very old subjects

Previous studies on the prevalence of signs of temporomandibular disorders (TMD) in elderly people have used non-standardized and invalidated examination protocols. The prevalence of the different signs of TMD in this group is therefore still unclear. The aim of this study was to evaluate the prevalence of signs of TMD in subjects of advanced aged, using a standardized and validated examination protocol. Additionally, young subjects were examined as a control group. Fifty-eight old peoples' home inhabitants and 44 young subjects were examined using a standardized and validated examination protocol. Differences between the groups were assessed using Mann-Whitney U-test or t-test. Geriatric subjects more often exhibited objective symptoms of TMD (38% exhibited joint sounds on opening), but rarely suffered from pain (pain at rest: 0%, joint pain: 0%, muscle pain: 12%). In contrast, young subjects rarely exhibited objective symptoms (joint sounds: 7%), but suffered more frequently from pain (facial: 7%, joint pain: 16%, muscle pain: 25%). The mandibular range of motion was higher in young subjects. Differences between the groups with respect to joint sounds, muscular palpation pain and mandibular range of motion were significant. Although older subjects more frequently exhibited objective signs (joint sounds) of TMD, they rarely suffered from pain. In contrast, younger subjects rarely exhibited objective TMD signs but more frequently suffered from subjective signs (muscular pain on palpation) and facial pain.

Practical management of internal derangements of the temporomandibular joint in partially and completely edentulous patients

The diagnosis and treatment of temporomandibular disorders must focus on the specific needs of individual patients. Anecdotal reports suggest that a number of therapeutic methods can be selectively prescribed. Treatment of partially and completely edentulous patients must also consider retention and stability of the denture base(s).